Adequately preparing for and containing global shocks, such as COVID-19, is a key challenge facing health systems globally. COVID-19 highlights that health systems are multilevel systems, a continuum from local to global. Goals and monitoring indicators have been key to strengthening national health systems but are missing at the supranational level. A framework to strengthen the global system—the global health actors and the governance, finance, and delivery arrangements within which they operate—is urgently needed. In this article, we illustrate how the World Health Organization Building Blocks framework, which has been used to monitor the performance of national health systems, can be applied to describe and appraise the global health system and its response to COVID-19, and identify potential reforms. Key weaknesses in the global response included: fragmented and voluntary financing; non-transparent pricing of medicines and supplies, poor quality standards, and inequities in procurement and distribution; and weak leadership and governance. We also identify positive achievements and identify potential reforms of the global health system for greater resilience to future shocks. We discuss the limitations of the Building Blocks framework and future research directions and reflect on political economy challenges to reform.
- Viewing the global health system as a ‘health system’ is key to improving our understanding of the system and reforming it in meaningful ways. This is particularly important in the face of COVID-19 response failures.
- The WHO Building Blocks framework provides a clear set of capacities and goals that can be used to study and appraise the global health system, helping to identify strengths, gaps, and potential areas for reform. It also lays the groundwork for the development of indicators adapted to the global level to monitor progress across each of the Building Blocks.
- The Building Blocks framework highlights areas of potential reform for the global health system, including (financing) increasing compulsory financing to ensure predictable and adequate funds to support global governance functions; (financing) greater pooled international funding, with consistent prioritisation and resource allocation systems; (human resources) greater enforcement of the implementation of the Code of Practice; (human resources) encourage more countries to offer emergency medical teams with skills in non-communicable diseases (NCDs) or public health; (medicines) increase transparency on prices and ensure that pricing of global common goods is negotiated in the interest of countries globally and remove barriers to production.
- Governance is a critical function underpinning and intersecting each of the Building Blocks. Although the diversity of actors and diverging interests could limit the global community's ability to reform the global health system, the costs and risks associated with COVID-19 and future pandemics could mobilise collective action for renewed solidarity in global health.
- Complexity science methods can and should complement the use of the Building Blocks to better understand the structure of the global health system, the interactions between system components, the relative weighting and importance of different Building Blocks, together with the potential consequences of reform options, to guide decision-making.
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